It's been a big week for renowned neurosurgeon Charlie Teo. He was named in the Australia Day Honours List for his services to medicine, but he's also been criticised for his recent moves to auction off the chance to watch him operate on cancer patients.

The charity package is called "Spend a day with Charlie Teo", and offers the buyer the chance to see the care involved in treating patients with brain tumours.. One aspect of the package is to occasionally watch a surgery take place.

The idea has been criticised by some, including Public Health Professor Simon Chapman., who argues it's putting patients in an awkward position by compromising privacy.

In an interview with Adam Spencer, Dr Teo acknowledged the concerns, but says the key consideration is the motive of the surgeon involved, "it would be terrible if someone offered this item and patient care were to be compromised," he said.

He also explained that he tries to avoid any negative impact on the patients, through hospital protocols to prevent infection, but also through his own rules.

"I would never approach the patient myself. I think that puts them in an awkward situation...I make sure someone else approaches them for their consent so they can easily say no, and thankfully we've had patients say no," he said.

"Secondly, if they ever have any concerns I always err on the side of, 'Look just don't sign the form, if there's any concerns at all, whether it's with you or your family, just don't sign the form'," he explained.

Typically the type of people who bid for the package are parents who have children with an interest in medicine, one of those, Peter, says his daughter loved the experience.

"They saw a man who works with passion and commitment, the kids thought it was a fantastic day...they started at 7.30, finished late at night and went back at 7.30 the next day."

In the end, Charlie Teo says he does it to create awareness.

"The reason I do it is for the greater good of the community, to try and get more money into research, to try and tell people brain cancer is not just a name or a disease...I think this personal experience allows people to see that cancer affects you and me."

THE Cancer Council NSW had auctioned the chance to witness surgery performed by the brain surgeon Charlie Teo to raise research funds, its chief executive said yesterday.

Speaking after the Herald revealed furious divisions in the medical profession over whether casual observers should be allowed into operating theatres, Andrew Penman said the council had offered the prize four times in the past two years.

He said any risk to the patient needed to be balanced against the value of research funds raised at auction and the benefit of allowing ordinary people to understand doctors' work better.

''I don't think it's materially different from other things we ask patients to do,'' such as join research trials, from which they received no personal benefit.

This position is at odds with that of the Royal Australasian College of Surgeons, which says non-medical visitors should not be allowed to attend. Its executive director of surgical affairs, John Quinn, said yesterday the college would seek Dr Teo's account of spectators he had invited, before considering further action.

Last year the college issued a formal policy discouraging the use of live broadcasts of operations at specialist conferences, saying the presence of an audience might encourage ''surgical grandstanding'' and distract doctors from patient care.

Michael Coglin, the chief medical officer of Healthscope, which manages the Prince of Wales Private Hospital where Dr Teo works, said inviting spectators was a practice of Dr Teo's, not one endorsed by the hospital.

A spokeswoman for NSW Health said there was no formal policy regarding non-medical spectators in public hospitals and no plans to develop one.

Macquarie University Hospital and St Vincent's Private Hospital said their policies allowed only visitors with legitimate supportive or educational roles in operating areas.

ScienceDaily (Apr. 24, 2011) — Neurosurgeons at the Krembil Neuroscience Centre, Toronto Western Hospital, have for the first time initiated the restoration of lost brain tissue through brain bypass surgery in patients where blood flow to the brain is impaired by cerebrovascular disease. The study, which involved 29 patients, was published online in the journal Stroke.

In cases where blood flow is reduced to the brain as a result of diseased blood vessels, patients experience a progressive loss of brain tissue. This loss of tissue, which comprises the grey matter of the brain, is believed to lead to decreased neurocognitive function (i.e. types of thinking, such as perception, memory, awareness, capacity for judgement) and may hasten the onset of dementia.

At approximately 11 months after patients in the study underwent brain bypass surgery, aimed at restoring blood flow to the brain, researchers observed a 5.1percent increase in the thickness of the brain tissue on MRI scans.

"We were pretty astounded when we saw the results because they were quite unexpected," said Dr. Tymianski. "Our goal with the surgery was to halt further loss of brain tissue due to strokes, so it was remarkable to see the loss was actually reversed."

This is the first surgical treatment which has been shown to restore lost brain tissue. The average age of the patients in the study was 41 years old.

"The re-growth of brain tissue has only been observed in an extremely limited number of circumstances," said Dr. Tymianski. "We consider this so important because one of the most important health issues facing our population is chronic cerebrovascular disease, which leads to neurocognitive impairment and reduces quality of life."

BOKARO: The doctors of neurosurgery department of Bokaro General Hospital (BGH) have performed a major brain surgery in which they first removed a major portion of skull from the patient's head and then preserved it inside his stomach for three months. They again repositioned it by doing a reconstructive surgery on Thursday.

The doctors had preserved the portion of skull in the stomach of the patient to prevent it from infections.

The team of doctors headed by neurosurgeon Anand Kumar, Anjali Sahu, Sujit Parera, Awadh Kumar and others successfully relocated the portion of skull on the head from the abdomen in a three-hour surgery at the hospital.

The doctors said such operations are rare here but it was successful. The patient, Honi Mahto (55), is recovering and would soon be released from the hospital," said BGH medical services director A K Singh.

Mahto, a mason by profession, was admitted to BGH on March 20 after he sustained grievous head injuries in a road accident. He was brought to the hospital in an unconscious state. The doctors, finding multiple blood clots and a damaged brain, had immediately operated upon it. The doctors removed the clot and the damaged portion of the brain. But the difficulty arose when they found that the pressure of the swollen brain was not released.

"The doctors then decided to preserve the removed piece of the skull inside the abdomen to prevent it from infection until it got fixed on the head. It is part of operational procedure which neurosurgeons perform during such surgeries after finding it difficult to place the removed skull on the head. About 30% of the skull was removed from the head during the operation and stored in stomach. The patient - a resident of Chandipur village in Kasmar block of - took about three months to recover. After the patient recovered, the doctors performed the reconstructive surgery and placed the portion of skull back to its his original position. The surgery is called cranioplasty," said a doctor of the surgery team.

But the kin of the patient are worried as they have no money left to buy medicines for treatment. The poor family members have appealed to residents to provide monetary help to them to meet his medical expenses. "Doctors have saved my father but we are worried about how we will meet his further expenses related to treatment. We have spent around Rs 5 lakh in the past three months in medicines, treatment and hospital. We have no money left now. I request to the people to provide me some financial assistance," said his only son.

MONDAY, June 20 (HealthDay News) -- Most U.S. cancer patients covered by Medicare receive appropriate surgical care at the nation's hospitals, a new study finds.

Researchers found that while most hospitals follow established practice surgical guidelines in treating these patients, some diverge from the guidelines. The study, published online June 20 in the journal Archives of Surgery, was partially funded by the American Surgical Association.

In the study, Dr. Caprice C. Greenberg, of Brigham and Women's Hospital in Boston, and colleagues analyzed national data on surgical treatment of Medicare patients aged 65 and older who were diagnosed with one of five types of cancer -- breast, colon, gastric, rectal or thyroid -- between January 2000 and December 2005. The study authors focused on 11 National Comprehensive Cancer Network (NCCN) guidelines for surgical care of cancer patients.

More than 90 percent of hospitals adhered to seven of the 11 guidelines. The guidelines most likely to be followed were those with a high NCCN rating.

Among those who were most likely to receive appropriate cancer care were patients who were white, younger, healthier, wealthier, had less-aggressive cancers and lived in the Midwest, the researchers found.

"It is critical that surgeons focus on generation of the data necessary to inform clinical decision making and promote high-quality surgical care," the study authors noted in a journal news release.

At 16, Shaina weighed 242 pounds. She also had developed a complication of obesity in which pressure builds up within the skull, damaging the optic nerve. The only solution for Shaina, who had already started to suffer vision loss, was to lose weight -- fast.

"Even though I lost 20 pounds on my own, I needed to lose like 50 pounds," Shaina says.

A doctor recommended bariatric surgery, and Shaina had the procedure in February 2011. Three months later, she is down to 184 pounds -- the first time she can remember weighing less than 200 -- and has gone from a size 20 to a 12. "I had to get a whole new wardrobe," she says.

More young people like Shaina, who are obese and often suffering from serious health complications, are undergoing operations to help them lose weight. While fewer than 1,000 teens have the surgery in the U.S. each year (versus 200,000 to 250,000 adults), it is becoming more common among adolescents as obesity rates continue to rise.

"There's certainly more and more cases done every year, and unfortunately we're likely going to continue to go that route," says Shaina's doctor, Evan Nadler, M.D., the director of bariatric surgery and codirector of the Obesity Institute at the Children's National Medical Center, in Washington, D.C.

Success stories like Shaina -- and those of celebrities like Al Roker and Star Jones -- might make bariatric surgery look easy. It's not. In fact, doctors are so concerned that teens might have unrealistic expectations that they require extensive presurgery evaluation and lifestyle changes to ensure that teens understand the serious risks, are dedicated to overhauling their health, and don't take the procedure lightly.

Surgery usually requires preliminary weight loss and then a strict postsurgical regimen of dietary changes, vitamins, and exercise. If the teen and his family aren't fully committed, the results can evaporate quickly or fail to materialize in the first place.

"We worry a lot if we have a child who thinks the surgery is going to be a magic fix," says Eleanor Mackey, Ph.D., a clinical psychologist at the Obesity Institute at Children's National Medical Center, who evaluates young people considering the surgery.

Not a cosmetic procedure

Bariatric surgery is not for the moderately overweight. Although there are no consensus national guidelines for bariatric surgery for adolescents, doctors generally follow the same national guidelines for adults: The patient should have a body mass index (BMI) of 40 or higher (for example, someone 5'4" would have to weigh at least 233 pounds to qualify), or a BMI of 35 (a weight of 204 for someone 5'4") or greater with serious obesity-related health problems, such as type 2 diabetes.

"This is not a cosmetic procedure," says Marc Michalsky, M.D., surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, in Columbus, Ohio. "Most of these kids are actually quite sick, and they feel quite sick."

Doctors usually don't perform the surgery on children until they have gone through puberty and have stopped growing. This is because there could be increased likelihood of a nutritional or vitamin deficiency after surgery, which could hinder bone growth and sexual maturation, Michalsky says.

In addition, a young person must have the psychological maturity and family support to make permanent lifestyle changes, explains Thomas Inge, M.D., the surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children's Hospital Medical Center.

"Two to three months are needed to really get to know the family and make sure the child really knows what they are getting into," Inge says. (The surgery may also require financial support: Many families pay out-of-pocket for the procedure, which usually costs between $10,000 and $20,000, although insurance companies do sometimes agree to cover it.)

Inge says it takes a team of pediatricians, psychologists, exercise physiologists, dietitians, and social workers to get a true sense of whether a teen is ready for the surgery and to help that patient prepare for the surgery and follow-up. For instance, surgeons typically require that a patient make lifestyle changes -- becoming more active and eating healthier -- before undergoing the surgery. Doctors can evaluate whether a patient has made sufficient changes by tracking her weight and performance in a quarter-mile walk test, Inge adds.

"We really look to make sure that kids are interested in the surgery, that they're not just being pushed into it, [and] that they have some understanding of what they're going to have to do to make sure their surgery is successful," Mackey says.

Life after surgery

The post-surgery recovery is no picnic. Patients stick to a liquid diet for weeks and then gradually phase in solid food.

"My body was different day to day," recalls Michelle Montanti, 19, who had the procedure when she was 15 and weighed 250 pounds. She has since lost 110 pounds. "One day I could tolerate mac and cheese; the next day I was throwing up. It's a really hard transition."

Shaina can still eat only soft food or food that has been mashed up.

Bariatric surgeons like to say that the surgery is just a tool, not a magic bullet. Multiple follow-up visits with the surgeon and support team are required in the first year, and in order to get results from the procedure, young people must be committed to becoming more active and eating healthier for life, which often requires getting their families to do the same.

"You really have to learn the difference between listening to your stomach and listening to your head," says Montanti, who is attending culinary school and aspires to make cooking and nutritional videos for other bariatric surgery patients. "You have to retrain your body how to eat."

Because bariatric surgery limits the amount of food patients can eat, adequate nutrition after surgery is important. Teen and adult patients alike need to take vitamins and minerals following surgery, in some cases for the rest of their lives. Iron is a common deficiency that puts patients at risk of anemia.

Malnutrition is a major concern for patients who undergo a type of bariatric surgery called gastric bypass, in which part of the stomach and small intestine gets bypassed, says Nadler. "If bypass patients stop taking multivitamins, it can result in life-threatening malnutrition."

In fact, because of the risk, Nadler performs only the other two types of weight-loss surgery -- gastric banding and sleeve gastrectomy, in which surgeons remove a large portion of the stomach. These types are less common than gastric bypass, but sleeve gastrectomy -- the surgery Shaina had -- is gaining in popularity, Nadler says.

In addition, patients have to follow other diet rules, especially in the months after surgery, to avoid malnutrition, dehydration, and weight gain. These include eating regular, high-protein meals and not drinking liquids close to mealtime.

Starting an exercise program is equally important for post-surgery weight loss. Brandy Sanders, 19, who weighed 383 pounds when she had surgery in February 2011, has been exercising with her mother for two hours a day. "Before I had the surgery, I could do seven minutes on the treadmill and I almost died," she says. "Yesterday I did 30 minutes and I was just huffing and puffing a little bit."

Brandy has lost 33 pounds so far, and her goal is to get down to 230 pounds. "It would still be a lot more than I should weigh, but it would be a lot better than what I started out with," she says.

Making changes without surgery

Sometimes just the process of preparing for surgery is enough to trigger serious lifestyle changes that can help teens avoid it. Although bariatric surgery is much safer since it was first introduced in the late 1960s, it does carry a risk of side effects and serious complications -- such as stomach leakage (after gastric bypass and sleeve gastrectomy) and malfunctioning gastric bands -- that can require corrective surgery.

Plus, there is little data on the potential long-term risks of bariatric surgery in adolescents. A recent study did show that young people lost bone mass after gastric bypass. (Inge and his colleagues don't see this as a major concern, given that these patients started out with a much higher-than-normal bone density.)

However, teens need to have their bone density checked annually for at least 10 years after surgery to make sure it's adequate, says Inge, who is currently recruiting teens for a 10-year study of bariatric surgery patients.

Some extremely obese teens find presurgery prep can even change their lives for the better. Josh Caudill, a high school senior in Austin, Ind., weighed 472 pounds and had tried the Atkins diet, Weight Watchers, and several fad diets when he decided to investigate weight-loss surgery. "I kept trying and I just couldn't do it," he says. "I was getting [to the point] where walking was hard."

He visited the bariatric surgery clinic at a hospital outside Indianapolis, and the doctors there told him he'd have to lose 40 pounds before he could be a candidate.

He asked one of his teachers, a vegetarian, for diet and exercise advice, and the two began taking regular walks together after school. Within two months he'd lost the 40 pounds, but he decided he wanted to lose more weight on his own. "Here I am 11 months in and I lost 122 pounds," he says. "I can jog a mile now. I lift weights probably five days a week."

Caudill has been accepted to Purdue University, and he hopes to be down to 315 pounds by summer. "My main goal is between 230 and 250," he says. "That's my life goal."

His father, who also struggles with obesity and recently had a second gastric bypass after regaining the weight he'd lost, urged him to get the surgery, Caudill says. "I think in some cases it's OK to have, but in my case, it's not for me."

In a way, you have to feel a little sorry for physicians who practice elective medicine: they’re facing the double whammy of a highly competitive marketplace and a down economy. Many aesthetic plastic surgeons, in particular, may be feeling the squeeze as patients postpone or abandon plans for more expensive procedures and visit low-cost clinics and medical spas for non-invasive treatments.

It’s no surprise, then, that marketing is a hot topic in aesthetic medicine today. Cosmetic surgeons are learning that they must market their practices or get left behind by others who do.

But marketing plastic surgery is tricky business for a few reasons. First, there’s the fact that—at least for surgical procedures—the worst that can happen is death. Although the risk of dying due to complications is quite small, it is not zero.

Next, no matter how careful you may be with your messages, when you market cosmetic procedures you are, at some level, encouraging people to feel that they should consider improving their looks. That they’re not okay just the way they are. These two points alone should give every plastic surgeon reason to pause and think through each move they make.

But, how is cosmetic surgery marketing regulated? What do you need to be aware of as you research plastic surgeons?

As you might guess, regulation is, to put it politely, a bit uneven. While agencies at the federal level oversee part of the picture—such as the Federal Trade Commission’s dominion over advertising practices (FTC 1)—the states are in charge of what’s ethical within their borders.

Here are some examples. The California medical board has enacted various regulations to protect consumers from deceptive marketing. Some relate to photography and how it is used. Others cover deceitful pricing. The state also bans the use of patient testimonials, as do Texas, New York and Illinois.

Some states are quite rigorous when it comes to punishing those who run afoul of the rules. Maryland, Michigan, North Carolina and Virginal view violations or their regulations as medical misconduct.

One of the women in my support group was scheduled for surgery last week to have the final step of her reconstruction done on her breasts.

She had months of the annoying expander series where they add fluid on a regular basis to stretch the skin to get ready for the implants after her mastectomy. This last step is highly anticipated since it sets a milestone on this crazy cancer journey. So at lunch we gave her a nice send-off with lots of love and encouragement. She was very emotional—nervous, yet relieved—to be done with this long process. The morning before the surgery, we all e-mailed our good thoughts and well wishes. The day of the surgery we received an e-mail, which said the hospital called last night to say her implants were on “back order.” That's like Starbucks running out of coffee or Baskin Robbins running out of ice cream. Good God!

The sores have returned to my mouth, and I am gargling and swishing with everything from salt water to Listerine. What else is there for this problem? I knew that one of the side effects of chemo is cracking nails and a dryness that can only be helped by lathering your hands with cream and wearing cotton gloves to bed. I did not know that fungus could start growing under your nails. This is not a good thing for someone who likes to give themselves a weekly manicure and wear pretty rings. Now I try to keep my hands on my lap. I have learned that fungus is one of the hardest conditions to get rid of. The over-the-counter remedies do not work. There's is an oral prescription drug that is supposed to work for 40 percent of those who take it. Do I add another drug into this compromised body of mine? If the fungus continues to spread I don't know what I will do. It's pretty gnarly looking. Google it.

A truly horrifying piece of news was released this week by Yale University. As I have mentioned in the past, breast cancer is not one disease. It is six or seven different diseases that all need to be treated with different protocols. This new study revealed at least 20 percent of breast cancers that were classified as triple negative were in fact estrogen receptor positive. This misdiagnosis means that these 20 percent of women have been undertreated. Being undertreated certainly does not help your survival rate. All these women need to have their tumors re-tested...that is if your hospital froze and saved your tumor. Egads! Nothing is easy? This new IHC (ImmunoHistoChemistry) test, which is the newer and more reliable version of the old IHC is not yet available. I am not in this category, as I am ER positive. My heart goes out to these women. Imagine realizing that you have not been taking a medicine that works at blocking your cancer so it will not spread? The trials and tribulations continue for all of us living with cancer. We may be weary, but we are warriors and we will not give up. Fight on my fellow survivors!

Please join me in this fight by joining Men for Women Now. We will send you updates on upcoming events, relevant news and ways that you can help. It will allow me to stay in touch with more of you so that together we can make a meaningful difference.

Having bariatric surgery doesn't mean you have to take it easy on exercise. A study finds that after surgery, exercising regularly at a moderate to vigorous pace may be perfectly fine -- and might improve one's quality of life.

The study, published online recently in the journal Obesity, assigned 33 people with an average BMI of 41 (considered class III obesity, or morbidly obese) to either a 12-week exercise program or to a control group. The exercise group started out expending 500 calories a week, gradually increasing that to reach a goal of burning 2,000 calories a week. Exercise was mostly done on a treadmill at a moderate to vigorous pace.

Both groups followed a diet recommended for people who have had bariatric surgery.

By the last month of the study, about half of the participants were burning those 2,000 calories a week via exercise, and more than 80% were burning at least 1,500 calories. They weren't cutting back on movement the rest of the time, since their steps per day went from about 4,500 to about 10,000. The exercise group also saw a 10% cardiovascular improvement relative to their body weight. Both groups lost about the same amount of weight, about 10 pounds.

Those who exercised also reported higher health-related quality of life scores compared with the control group in areas such as physical function, self-esteem and energy levels.

"Until now, we didn't know until now whether morbidly obese bariatric surgery patients could physically meet this goal," said senior author Dr. Abhimanyu Garg of UT Southwestern Medical Center, in a news release. "Our study shows that most bariatric surgery patients can perform large amounts of exercise and improve their physical fitness levels."

Patients could die because of rising NHS waiting lists for tests and treatment, the leader of Britain's hospital doctors has warned. Delays in identifying conditions such as cancer may mean that a patient's illness reaches the stage where surgery or drugs cannot save them, Dr Mark Porter told the Guardian.

Porter, chairman of the British Medical Association's consultants committee, said the growing delays were "inhumane" because the ensuing uncertainty added to patients' fear and suffering.

His remarks will add to the pressure on David Cameron, who has offered several recent personal guarantees that patients will not have to endure long waits to be treated.

A Guardian analysis of official NHS data on England's six main waiting time targets shows that five are increasingly being breached. The number of patients waiting more than six weeks for a diagnostic test such as an MRI scan has quadrupled in the last year, an extra 2,400 people a month are not being treated within 18 weeks, and 200,000 patients waited longer than four hours in A&E this year compared with the same period in 2010, the data reveals.

The growing number not being tested or treated within the required time limits was of particular concern, Porter said. "If patients are now exceeding those times, then those patients' treatment options are being limited, and if that happens then there's a potential for patients suffering harm.

"It may be that someone's disease progresses beyond the point where surgery might usually give a cancer patient a potential cure, but the patient then receives palliative care only," he said.

Previous success in ensuring patients did not experience long waits was at risk from the government's changes to the service and its £20bn efficiency drive, Porter said. "There's definitely a potential for patient harm from these growing waiting time problems. Patients will be waiting with anxiety and pain longer than they should be. That's inhumane."

Other medical leaders also expressed alarm. Professor Tim Evans, a vice-president of the Royal College of Physicians, said he was concerned about the small but growing number of cancer patients having to wait more than one or two months for treatment. "If you've just had a diagnosis of cancer, you want treatment as soon as possible, obviously. Therefore the fact that more patients are waiting longer, even small numbers, is a matter of great concern to clinicians. If you need treatment for cancer, the earlier you get it the better," said Evans. "Patients having to wait more than 31 or 62 days for their first treatment would feel anxious and concerned and require reassurance that this isn't going to affect their prognosis."

Doctors are also concerned that the number of patients waiting more than six weeks for a diagnostic test has risen from 3,378 to 15,667 in the last year. While only 2.7% of patients wait this long, the figure is 8.6% for those awaiting a colonoscopy and 8% for flexible sigmoidoscopy, another test for cancer.

"Waiting times for diagnostic imaging tests are showing a worrying trend upward," said the Royal College of Radiologists. "Radiologists and radiographers are trying their best to address the rise in waiting times for diagnostic imaging by working extended hours and weekends, but it is difficult to keep pace with increasing demand."

Professor Jon Rhodes, president of the British Society of Gastroenterology, said the rise in waits for procedures such as colonoscopy was "alarming". He added: "No one should have to wait more than four weeks for a diagnostic colonoscopy, since delayed diagnosis is a major factor underlying the country's relatively poor survival rates for colorectal cancer." The NHS had too few endoscopists to cope with demand, he added.

NHS data shows that while in May 2010, 337 patients had waited beyond six weeks for a colonoscopy, that had risen to 2,313 in May this year. Similarly, the number waiting past six weeks for flexible sigmoidoscopy has jumped from 87 to 1,199, and those waiting for echocardiography from 574 to 2,034 over the same period.

Dr Peter Carter, general secretary of the Royal College of Nursing, warned that the government's health policies were worsening the situation. Abolishing primary care trusts, the NHS bodies charged with ensuring patients are treated within time limits, had weakened patients' rights, he said. Making more patients wait longer would prove to be "a false economy" for the NHS, as some would require more extensive treatment as a result, he said.

The NHS's deputy chief executive, David Flory, wrote to NHS providers last month warning them to improve "unacceptable" performance on the 18-week limit, after 47 trusts missed one or both targets involved and 32 did not meet the requirement to treat 95% of emergency patients within four hours of their arriving at A&E. New NHS data out later this week, and the latest quarterly NHS performance monitoring report from the King's Fund thinktank, are expected to cast further doubt on promises – also made by the health secretary, Andrew Lansley – to keep waiting times low.

The Department of Health denied that waiting times were becoming a problem. "Waiting times are low and have been broadly stable since 2008. The latest figures show that 90.5% of admitted patients and 97.5% of non-admitted patients started treatment in under 18 weeks," said a spokeswoman.

A group of women with ovarian tumours have become the first in the world to have surgery using a procedure that makes cancer light up in the body.

Operations were performed on 10 women as part of the first phase of a clinical trial to evaluate the technique, called fluorescence-guided surgery.

Doctors developed the procedure to help surgeons remove malignant tissue from ovarian cancer patients and reduce the risk of the disease returning months and years later.

The method illuminates cancer cells inside a patient's body to make it easier for surgeons to spot smaller cancers that can be easily missed, and to help them identify the borders between tumours and the healthy tissues that surround them.

Figures from 2008 show that 6,537 women were diagnosed with ovarian cancer and 4,373 died from the disease, according to Cancer Research UK. The disease is more likely to return if malignant cells remain in the body after surgery.

Many ovarian cancer patients have operations to remove or reduce the size of tumours before they receive other anti-cancer treatments, such as chemotherapy. But distinguishing tumours from healthy tissue can be difficult, with surgeons relying on a combination of feel and appearance to decide what material to remove.

With the new technique, surgeons could spot clusters of cancer cells as small as one tenth of a millimetre across, compared with around 3mm using visual and manual inspections. Doctors believe it will reduce relapses in the disease, caused by malignant tissue re-growing after patients have had surgery.

"Ovarian cancer is notoriously difficult to see, and this technique allowed surgeons to spot a tumour 30 times smaller than the smallest they could detect using standard techniques," said Philip Low at Purdue University in Indiana. "By dramatically improving the detection of the cancer, by literally lighting it up, cancer removal is dramatically improved."

Doctors performed operations on 10 women aged 41 to 76. Five had benign tumours, four had malignant cancer and one had a borderline tumour.

Before surgery, patients were injected with a liquid that contained a fluorescent dye attached to a chemical called folate. These build up in ovarian tumours because they contain more "folate receptors" than healthy tissue. During surgery, patients lay under a camera system that shone laser light on to the body. It detected which cells fluoresced and displayed them on a screen beside the patients.

"You see the image in real time as you work. You can zoom in and operate using the fluorescence," said Gooitzen van Dam, a cancer surgeon who led the study at Groningen University in the Netherlands. The operations are described in the journal Nature Medicine.

The surgeons found on average 34 tumours, compared with just seven picked up by traditional observations alone.

"This system is very easy to use and fits seamlessly into the way surgeons do open and laparoscopic surgery, which is the direction most surgeries are headed in the future," Van Dam said. "I foresee it becoming a new standard in cancer surgery in a very short time."

Much larger trials over longer periods are needed before doctors can be sure the procedure improves survival from ovarian cancer, but it is known already that follow-up treatments, including chemotherapy and radiotherapy, are more successful when less cancerous tissue is left in the body.

"What we are really after is a better outcome for patients, but if we had instead designed the clinical trial to evaluate the impact of fluorescence-guided surgery on life expectancy, we would have had to follow patients for years," Low said.

"By instead evaluating if we can identify and remove more malignant tissue with the aid of fluorescence imaging, we are able to quantify the impact of this novel approach within two hours after surgery. We hope this will allow the technology to be approved for general use in a much shorter time."

The team has ethical approval to trial the system on breast cancer patients and expects to perform several operations in the next two months. The method should reduce cases where too much breast tissue is removed, a problem that can lead to more mastectomies and more complex cosmetic surgery after cancer treatment.

Around 6,800 cases of ovarian cancer are identified in the UK each year. It is notoriously difficult to detect and often spotted at a late stage, by which time it is incurable. Two-thirds of those diagnosed will die from the disease.

Surgeons using traditional detection methods, which rely on vision and touch, often miss small tumours – containing clusters of cells which are less than three millimetres wide.

However, those involved in a trial of the new flureoscence-guided technique found an average of 34 tumours – compared with an average of seven using current methods.

The inventor of the technology, biochemistry professor Philip Low, from Purdue University in Indiana in the U.S., said: ‘Ovarian cancer is notoriously difficult to see, and this technique allowed surgeons to spot a tumour 30 times smaller than the smallest they could detect using standard techniques.

‘By dramatically improving the detection of the cancer – by literally lighting it up – removal is dramatically improved.’

The excitement follows the success of ten trial operations. Researchers added a fluorescent marker to a form of folic acid – which becomes attached to ovarian cancer cells – which they injetced into patients two hours before surgery.

Using a special camera, they were able to illuminate the cancer cells and display them as green glowing patches on a monitor. It is hoped the new method will enable surgeons to remove small tumours which would otherwise be missed, possibly causing the cancer to regrow.

Even if the cells cannot all be removed, minimising what is left improves the chances of success of chemotherapy or immunotherapy.

Professor Gooitzen van Dam, of the University of Groningen in the Netherlands, where the trials took place, said: ‘I think this technology will revolutionize surgical vision. I foresee it becoming a new standard in cancer surgery in a very short time.’

Professor Peter Johnson, Cancer Research UK’s chief clinician, added: ‘We know that one of the most important things for people with ovarian cancer is that as much of it as possible should be removed by an operation, and that the better this can be done, the higher the chances of survival.

‘This may be a promising way to improve the results of surgery in the future.’

The technology is based on Professor Low’s discovery that many cancer cells are hungry for folic acid, a form of vitamin B, which helps them grow. Cancers of the womb, lung, kidney, breast and colon all absorb the acid, but ovarian cancer is one of the biggest consumers.

A simple test can determine if patients’ cancer cells could be detected by the new technique, according to the report published in the journal Nature Medicine.

‘With ovarian cancer it is clear that the more cancer you can remove, the better the prognosis for the patient,’ Professor Low said.

‘This is why we chose to begin with ovarian cancer. It seemed like the best place to start to make a difference in people’s lives.’

Since the 1970s, the incidence of ovarian cancer in women aged 65 and over has increased by more than half. Overall, it is the fifth most common cancer for women.

Professor Low hopes that, after more trials, his technique will be used in all ovarian cancer surgery.

Oct. 3, 2011 -- There are new concerns about an increased risk for learning problems in very young children exposed to general anesthesia during surgical procedures.

Researchers from the Mayo Clinic in Rochester, Minn., found a twofold increase in learning disabilities in children who had more than one exposure to general anesthesia with surgery before age 2.

The study is published in the November issue of Pediatrics.

The FDA requested and funded the study. Last spring, an FDA panel met to review the research examining the effect of early exposure to anesthesia on the developing brain.

Following the meeting, FDA director of anesthesia and analgesia products Bob Rappaport, MD, wrote that additional studies are needed. He noted that "at present, there is not enough information to draw any firm conclusions" about the long-term impact of early exposure to general anesthesia on the brain.

The new study adds to the evidence linking repeated exposure to general anesthesia very early in life to an increased risk for learning disabilities, but it does not prove the link, says Randall Flick, MD, who led the Mayo research team.

"I fully support the FDA's conclusion that we do not yet have sufficient information to prompt a change in practice," he tells WebMD.

Anesthesia and the Developing Brain
Each year in the U.S., millions of babies and toddlers have surgeries that require general anesthesia. These surgeries range from lifesaving operations to elective procedures.

Studies in rodents and monkeys have repeatedly shown that exposure to anesthesia at a very young age kills brain cells.

In 2009, Flick and colleagues reported that children exposed to general anesthesia during surgery on two or more occasions before age 4 had a twofold increase in learning disabilities when they reached school age.

Their latest research expands on this work by considering the potential impact on brain development of the illness that made the surgery necessary in the first place, Flick says. One criticism of the earlier work, he says, was that the role of other existing illnesses was not taken into account.

"Sick children have more learning disabilities and sick children require more surgeries," Flick says.

The study included 1,050 children born between 1976 and 1982 in a single school district in Rochester, Minn., enrolled in a larger health study.

A total of 350 children who had one or more surgeries requiring general anesthesia before age 2 were compared to 700 children with no such history.

Among the major findings:

About 37% of children who had had multiple surgeries requiring general anesthesia before age 2 had learning disabilities, compared to 24% of children who had just one surgery and 21% of children who had no surgeries.
After factoring in the impact of health status, having two or more surgeries requiring general anesthesia was associated with a twofold increase in learning disabilities.
Children who had two or more surgeries prior to age 2 were three to four times as likely to have been identified by their schools as needing special help for language and speech difficulties through an individualized education program (IEP) mandate.

Who is online

Users browsing this forum: Google [Bot] and 1 guest

You cannot post new topics in this forumYou cannot reply to topics in this forumYou cannot edit your posts in this forumYou cannot delete your posts in this forumYou cannot post attachments in this forum